Incidence Of Harm Research Articles

Lipid-lowering efficacy of rosuvastatin.

Rosuvastatin is one of the most potent statins and is currently widely prescribed. It is therefore important to know the dose-related magnitude of effect of rosuvastatin on blood lipids. Primary objective To quantify the effects of various doses of rosuvastatin on serum total cholesterol, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol, non-HDL-cholesterol and triglycerides in participants with and without evidence of cardiovascular disease. Secondary objectives To quantify the variability of the effect of various doses of rosuvastatin.To quantify withdrawals due to adverse effects (WDAEs) in the randomized placebo-controlled trials. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 10 of 12, 2014 in The Cochrane Library, MEDLINE (1946 to October week 5 2014), EMBASE (1980 to 2014 week 44), Web of Science Core Collection (1970 to 5 November 2014) and BIOSIS Citation Index (1969 to 31 October 2014). No language restrictions were applied. Randomized controlled and uncontrolled before-and-after trials evaluating the dose response of different fixed doses of rosuvastatin on blood lipids over a duration of three to 12 weeks. Two review authors independently assessed eligibility criteria for studies to be included and extracted data. WDAEs information was collected from the placebo-controlled trials. One-hundred and eight trials (18 placebo-controlled and 90 before-and-after) evaluated the dose-related efficacy of rosuvastatin in 19,596 participants. Rosuvastatin 10 to 40 mg/day caused LDL-cholesterol decreases of 46% to 55%, when all the trials were combined using the generic inverse variance method. The quality of evidence for these effects is high. Log dose-response data over doses of 1 to 80 mg, revealed strong linear dose-related effects on blood total cholesterol, LDL-cholesterol and non-HDL-cholesterol. When compared to atorvastatin, rosuvastatin was about three-fold more potent at reducing LDL-cholesterol. There was no dose-related effect of rosuvastatin on blood HDL-cholesterol, but overall, rosuvastatin increased HDL by 7%. There is a high risk of bias for the trials in this review, which would affect WDAEs, but unlikely to affect the lipid measurements. WDAEs were not statistically different between rosuvastatin and placebo in 10 of 18 of these short-term trials (risk ratio 0.84; 95% confidence interval 0.48 to 1.47). The total blood total cholesterol, LDL-cholesterol and non-HDL-cholesterol-lowering effect of rosuvastatin was linearly dependent on dose. Rosuvastatin log dose-response data were linear over the commonly prescribed dose range. Based on an informal comparison with atorvastatin, this represents a three-fold greater potency. This review did not provide a good estimate of the incidence of harms associated with rosuvastatin because of the short duration of the trials and the lack of reporting of adverse effects in 44% of the placebo-controlled trials.

Alcohol age of initiation and long-term impact: a cross sectional survey of adults in England

Background: Worldwide alcohol consumption is involved in 2.5 million deaths annually. Worryingly, the age of alcohol initiation may be decreasing; evidence suggests an inverse correlation between initiation and prevalence of alcohol use. European data are limited.Methods: Data are from a survey (n = 2638) on alcohol consumption of ≥18 y in England. Univariate and multivariate associations are reported between demography, last year alcohol consumption, historic drinking including having regularly drank alcohol <18 y (drank at least monthly), and experience of at least one serious alcohol-related problem (self-defined).Results: Lifetime alcohol consumption was reported by 93.2% of participants. Of these, 36.1% reported regular consumption <18 y; 18–30 y had a threefold greater odds of reporting alcohol consumption <18 y than 61–75 y. In total, 5.2% reported at least one serious alcohol-related problem; those who had regularly consumed alcohol <18 y had a twofold greater odds of reporting this than those who had not.Conclusion: Our sample supports a potential increase in the proportion of those reporting underage alcohol initiation. As those who regularly consumed alcohol <18 y were at risk of experiencing alcohol-related problems, incidence of harm could increase over time as early initiators start to experience harms, supporting the need for interventions to delay alcohol consumption in underage groups.

Intimate war

Contending that domestic violence and modern international warfare are part of a single complex of violence, this paper identifies their shared intimate dynamics. Both violences operate through emotional and psychological registers that are as central to their effectiveness as incidents of direct physical harm. While these dynamics are intimate, they are present across scale, and read here through a feminist lens on intimacy-geopolitics where neither framing has primacy. Research on the connections between domestic violence and international warfare is longstanding, most recently highlighting how intimate violence is produced within warzones. The analysis here begins instead from intimate dynamics, to draw out the warlike nature of domestic violence in peacetime. Tactics of modern warfare are juxtaposed with the dynamics of domestic violence in suburban Scottish homes: shock and awe, hearts and minds, cultural and psychological occupation, just war and collateral damage. Resisting the temptation to regard domestic violence as everyday militarism, the relation is rotated: both violences continuously wind through the intimate-geopolitical. This spatial reconfiguration is structured by gender, race, class, nation and citizenship, resulting in uneven impacts from all kinds of intimate war. The interweaving of military and intimate themes is intended as a casting-off point for progressing political geographies that are attentive to intimacy as foundational in the workings of power across scale.

Serious harm from inpatient hypoglycaemia: a survey of hospitals in the UK

To estimate the incidence of serious harm to inpatients with diabetes from hypoglycaemia. An anonymised questionnaire was e-mailed to lead organisers at the 142 acute NHS Trusts that contributed to the National Diabetes Inpatient Audit 2012. Each diabetes team was asked collectively to recall and report any serious adverse events from inpatient hypoglycaemia in the previous year. A total of 83 Trusts agreed to participate. Serious harm was defined as death, a cardiac or cerebral event or a fall resulting in permanent physical injury or fracture. A total of 41 Trusts returned the survey. Of these, only 28 (68.3%) were confident that robust methods existed in their Trust to ensure all such events were reported, and only 23 (56.1%) were confident that all such events were reported to the diabetes team. Despite these reporting concerns, the retrospective nature of the survey and the reliance on recall, 12 serious adverse events were reported from nine trusts: three deaths; two cases of permanent cerebral damage; two successfully resuscitated cardiac arrests; three seizures; and two undefined events. Insulin therapy was implicated in 10 events. Importantly, three events with two deaths occurred in patients who had received insulin/dextrose to correct hyperkalaemia; only one of whom had diabetes. An alarming number of serious adverse events was reported: 12 serious adverse events with three deaths over a 1-year period in 41 Trusts. This may be the tip of the iceberg, considering the potential under-reporting. Robust reporting mechanisms are required to determine the full extent of this serious preventable harm.

Assessing the representativeness of population-sampled health surveys through linkage to administrative data on alcohol-related outcomes.

Health surveys are an important resource for monitoring population health, but selective nonresponse may impede valid inference. This study aimed to assess nonresponse bias in a population-sampled health survey in Scotland, with a focus on alcohol-related outcomes. Nonresponse bias was assessed by examining whether rates of alcohol-related harm (i.e., hospitalization or death) and all-cause mortality among respondents to the Scottish Health Surveys (from 1995 to 2010) were equivalent to those in the general population, and whether the extent of any bias varied according to sociodemographic attributes or over time. Data from consenting respondents (aged 20–64 years) to 6 Scottish Health Surveys were confidentially linked to death and hospitalization records and compared with general population counterparts. Directly age-standardized incidence rates of alcohol-related harm and all-cause mortality were lower among Scottish Health Survey respondents compared with the general population. For all years combined, the survey-to-population rate ratios were 0.69 (95% confidence interval: 0.61, 0.76) for the incidence of alcohol-related harm and 0.89 (95% confidence interval: 0.83, 0.96) for all-cause mortality. Bias was more pronounced among persons residing in more deprived areas; limited evidence was found for regional or temporal variation. This suggests that corresponding underestimation of population rates of alcohol consumption is likely to be socially patterned.

Mycophenolate mofetil versus methotrexate for prevention of graft-versus-host disease in people receiving allogeneic hematopoietic stem cell transplantation.

Allogeneic hematopoietic stem cell transplantation (allo-HCT) is associated with improved outcomes for people with various hematologic diseases; however, the morbidity and mortality resulting from acute and subsequently chronic graft-versus-host disease (GVHD) pose a serious challenge to wider applicability of allo-HCT. Intravenous methotrexate in combination with a calcineurin inhibitor, cyclosporine or tacrolimus, is a widely used regimen for the prophylaxis of acute GVHD, but the administration of methotrexate is associated with a number of adverse events. Mycophenolate mofetil, in combination with a calcineurin inhibitor, has been used extensively in people undergoing allo-HCT. Conflicting results regarding various clinical outcomes following allo-HCT have been observed when comparing mycophenolate mofetil-based regimens against methotrexate-based regimens for acute GVHD prophylaxis. to assess the effect of mycophenolate mofetil versus methotrexate for prevention of acute GVHD in people undergoing allo-HCT. to evaluate the effect of mycophenolate mofetil versus methotrexate for overall survival, prevention of chronic GVHD, incidence of relapse, treatment-related harms, nonrelapse mortality, and quality of life. We searched Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE from inception to March 2014. We handsearched conference abstracts from the last two meetings (2011 and 2012) of relevant societies in the field. We searched ClinicalTrials.gov, Novartis clinical trials database (www.novctrd.com), Roche clinical trial protocol registry (www.roche-trials.com), Australian New Zealand Clinical Trials Registry (ANZCTR), and the metaRegister of Controlled Trials for ongoing trials. Two review authors independently reviewed all titles/abstracts and selected full-text articles for inclusion. We included all references that reported results of randomized controlled trials (RCTs) of mycophenolate mofetil versus methotrexate for the prophylaxis of GVHD among people undergoing allo-HCT in this review. Two review authors independently extracted data on outcomes from all studies and compared prior to data entry and analysis. We expressed results as risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes and hazard ratios (HR) and 95% CIs for time-to-event outcomes. We pooled the individual study effects using the random-effects model. Estimates lower than one indicate that mycophenolate mofetil was favored over methotrexate. We included three trials enrolling 177 participants (174 participants analyzed). All participants in the trials by Keihl et al. and Bolwell et al. received cyclosporine while all participants enrolled in the trial by Perkins et al. received tacrolimus. However, the results did not differ by the type of calcineurin inhibitor employed (cyclosporine versus tacrolimus). There was no evidence for a difference between mycophenolate mofetil versus methotrexate for the outcomes of incidence of acute GVHD (RR 1.25; 95% CI 0.75 to 2.09; P value = 0.39, very low quality evidence), overall survival (HR 0.73; 95% CI 0.45 to 1.17; P value = 0.19, low-quality evidence), median days to neutrophil engraftment (HR 0.77; 95% CI 0.51 to 1.17; P value = 0.23, low-quality evidence), incidence of relapse (RR 0.84; 95% CI 0.52 to 1.38; P value = 0.50, low-quality evidence), non-relapse mortality (RR 1.21; 95% CI 0.62 to 2.36; P value = 0.57, low-quality evidence), and incidence of chronic GVHD (RR 0.92; 95% CI 0.65 to 1.30; P value = 0.62, low-quality evidence). There was low-quality evidence that mycophenolate mofetil compared with methotrexate improved platelet engraftment period (HR 0.87; 95% CI 0.81 to 0.93; P value < 0.0001, low-quality evidence). There was low-quality evidence that mycophenolate mofetil compared with methotrexate resulted in decreased incidence of severe mucositis (RR 0.48; 95% CI 0.32 to 0.73; P value = 0.0006, low-quality evidence), use of parenteral nutrition (RR 0.48; 95% CI 0.26 to 0.91; P value = 0.02, low-quality evidence), and medication for pain control (RR 0.76; 95% CI 0.63 to 0.91; P value = 0.002, low-quality evidence). Overall heterogeneity was not detected in the analysis except for the outcome of neutrophil engraftment. None of the included studies reported any outcomes related to quality of life. Overall quality of evidence was low. The use of mycophenolate mofetil compared with methotrexate for primary prevention of GVHD seems to be associated with a more favorable toxicity profile, without an apparent compromise on disease relapse, transplant-associated mortality, or overall survival. The effects on incidence of GVHD between people receiving mycophenolate mofetil compared with people receiving methotrexate were uncertain. There is a need for additional high-quality RCTs to determine the optimal GVHD prevention strategy. Future studies should take into account a comprehensive view of clinical benefit, including measures of morbidity, symptom burden, and healthcare resource utilization associated with interventions.

Why research freedom is crucial to science.

Government bodies rely on evidence based science in order to make healthcare recommendations to the general public. In turn, members of the public trust that the scientific information that is being given to their doctors is based on evidence, allowing them to feel confident in the treatment they receive. For research institutions, integrity in research is extremely important because poor results of newly developed drugs or surgical procedures or incidences of harm to the public can affect their reputation and funding and ultimately hinder the advancement of science.

Quantification of loss and gain in performance using survey data: a study of earthquake-induced damage and restoration of residential buildings

This paper presents a method to assess and quantify changes in performance states of systems. The method is based on survey data containing performance states graded in a suitable scale. The changes in performance states are modelled using an association matrix obtained as a frequency table of measured performance states before and after an influential incident. Performance deviation, for both negative effects induced by a harmful incident and positive effects due to a constructive incident, is modelled. Relative change in performance is quantified by defining loss and gain matrices. Hadamard products of loss/gain matrices and the association matrix obtained from survey data are used to quantify performance deviation matrices. Finally, the overall change in performance is defined in terms of a performance deviation index, which is obtained by using the sum of the elements of performance deviation matrices. This index can be negative, zero or positive, and its value represents the degree of change in performance. A negative index indicates loss in performance; a zero index implies no measurable change, and a positive index means a gain in performance. An example application of the presented methodology for earthquake-induced damage and the subsequent restoration of residential buildings in South Iceland is presented.

Internet of Things as Intimating for Pregnant Women’s Healthcare: An Impending Privacy Issues

Ingeniously, the innovations are taking place in current medical era, where IoT is a key and its related technology plays a dynamic role in pregnant women care taking inside hospital and outside. IoT ensure the effective and efficient care of pregnant women in any environment because intelligent tiny devices like RF-Tags, sensors are attached with pregnant women, and all the activities of pregnant women can be monitored by professional medical staff from anywhere and anytime. The usage of these advanced technologies in pregnant women care environment, absolutely eradicates the pregnancy complications and harmful incidents, but also raises privacy, religious, ethical, legal and social issues. The purpose of this paper is to discuss the usage of IoT in pregnant women healthcare environments and articulates endorsements to promote research then can guarantee that the pregnant women’s privacy is preserved. DOI : http://dx.doi.org/10.11591/telkomnika.v12i6.4227 Full Text: PDF

Reputational risk in banking and finance: An issue of individual responsibility?

This paper considers the changing impact of reputational risk in financial services, notably since and during the financial crisis of 2007–2009. It begins by identifying the reputational risks that firms in the industry encounter, defining what constitutes that risk and the variety of losses and business damage that are wrought by reputationally harmful incidents. It goes on to examine the ‘special’ nature of financial services and why the reputation of financial institutions is particularly important. The paper then considers the role of personal responsibility and cultural factors in the creation of robust corporate governance. It examines the changing methods by which regulators and the industry itself are now looking to address these cultural issues to create a framework that is more resilient to reputational risk and conducive to personal liability for breaching regulations. It concludes by discussing the role of managerial leadership in achieving sound corporate governance.

Developing and testing a framework to measure and monitor safety in healthcare.

The NHS excels at measuring incidences of past harm – whether it is falls or hospital-acquired infections – but research undertaken by Charles Vincent, Jane Carthey and Susan Burnett for the Health Foundation suggests past harm is only one element of what is needed to understand how safe care is. The researchers developed a framework to incorporate other necessary elements, such as anticipating and preparing for risks before they lead to harm to patients. In 2013, the Health Foundation road-tested this framework with staff in three NHS organisations and held a two-day summit with leaders from across the healthcare system to get feedback on its potential. This article presents the findings of this phase of work and sets it in the context of recent changes in the policy and regulatory landscape for patient safety in England. It concludes that the framework offers a great deal of potential for supporting organisations to understand the safety of their services. The framework could be most effective when used to identify the relative strengths and weaknesses of current safety measures, and when staff are given sufficient time, resource and support to consider the complex issues surfaced by the questions in the framework. This needs to be matched by a system of regulation which is aligned and mature, and an approach from NHS Trust Boards which welcomes information about the risks of its services.

Cannabis, risk and normalisation: evidence from a Canadian study of socially integrated, adult cannabis users

Howard Parker’s ‘normalisation thesis’ has made a significant contribution to youth drug studies in many countries. Parker’s thesis has been less investigated, however, for its application across the life course, and few scholars have considered its utility for assessments of the meaning and experience of drug-related health risks. This article adds to discussions of drugs, normalisation and risk by analysing qualitative data collected from 165 long-term cannabis users aged 20–49 years in four Canadian provinces between 2008 and 2010. We focus on participants’ assessments of the risks and harms associated with persistent cannabis use and the strategies they employed to mitigate these risks. Our findings indicate important distinctions between culturally mediated conceptions of cannabis-related risks and the more narrowly grounded perception of cannabis harms based on personal or peer experience. These distinctions correspond with participants’ reports of a significant shift in cannabis’ risk profile in Canada. Participants attributed this shift to three factors: the growing prevalence of cannabis use; the rise of ‘medical marijuana’ and renewed attention to the drug’s therapeutic benefits and what they perceived to be the low incidence of cannabis-related harms in Canada. We conclude that understanding how health risks are assessed and managed by cannabis users should help to clarify how and why more tolerant attitudes about cannabis have emerged in Canada and how this change may impact on non-users’ expectations about any future initiation of use. We close by reflecting on the implications of our findings for cannabis-related public health, education and harm reduction initiatives.

The weathering performance of acrylic melamine automotive clearcoats containing hydrophobic nanosilica

This work is an attempt to study the effect of weathering on various properties of a typical acrylic melamine clearcoat containing various loads of nanosilica. It was found that nanosilica caused an incomplete curing process of the acrylic melamine clearcoat, leading to a lower crosslink density and also less Young’s modulus of clearcoat compared to the pure clearcoat. Thermo-mechanical analyses showed that incomplete curing of nanocomposites induced post-curing reactions during weathering, leading to an increase of crosslinking density and Young’s modulus of nanocomposites. Viscoelastic studies showed that incorporation of nanosilica into acrylic melamine resulted in more plastic behavior and higher elongation at break of clearcoats during weathering. In addition, gloss retention, surface topology, and chemical structure investigations revealed that nanosilica particles enhanced weathering performance of clearcoats. This was explained by UV–Visible spectroscopy which confirmed the ability of silica to absorb the harmful incident rays, protecting the clearcoat against weathering degradation.

What is the Best Way to Supervise the Quality of Medical Devices? Searching for a Balance Between ex-ante and ex-post Regulation

This article discusses the legal remedies available for Competent Authorities, patients and healthcare professionals to prevent harmful incidents involving medical devices. It outlines a theoretical framework for ex-ante and ex-post regulation of medical devices. It then focuses on certain aspects of ex-post regulation. Participation by Competent Authorities with a supervisory role, healthcare professionals and patients in ex-post regulatory legal processes is analysed in the light of the current European Union legal framework and the revised framework proposed by the European Commission. It also discusses whether the proposed new legal framework enables the Competent Authorities, patients and healthcare professionals to prevent the harm caused by unsafe medical devices. Ex-ante regulation might prevent the entrance on the market of unsafe devices whereas ex-post regulation might dismiss the unsafe devices. The contribution concludes by suggesting a number of improvements to the supervisory system of medical devices in Europe.

Development of an Australian version of the Alcohol-Related Problems Survey: A comprehensive computerised screening tool for older adults

The Alcohol-Related Problems Survey (ARPS) reliably classifies drinking as non-hazardous, hazardous or harmful using scoring algorithms that consider quantity and frequency of alcohol use alone and in combination with health conditions, medication-use and functional status. Because it has been developed using a 14-g US standard drink, it is not valid in Australia where a standard drink contains 10 g of ethanol. We recalibrated the ARPS scoring algorithms for a 10-g Australian standard drink and updated the list of medications. The Australian ARPS (A-ARPS) was then administered to 50 non-treatment-seeking participants in waves of five. The A-ARPS recalibrated scoring algorithms reliably classified all 50 individuals. Sixty-six per cent were classified as hazardous or harmful drinkers. Many were taking medications that interact with alcohol or had medical conditions that can be exacerbated by alcohol consumption. The A-ARPS is available for use in Australia. Its utilisation could reduce the incidence of alcohol-related harms.

Metric-driven harm: An exploration of unintended consequences of performance measurement

Performance measurement is an increasingly common element of the US health care system. Typically a proxy for high quality outcomes, there has been little systematic investigation of the potential negative unintended consequences of performance metrics, including metric-driven harm. This case study details an incidence of post-surgical metric-driven harm and offers Smith's 1995 work and a patient centered, context sensitive metric model for potential adoption by nurse researchers and clinicians. Implications for further research are discussed.

Individualisation in crisis planning for people with psychotic disorders

Background. In England, people with a serious mental illness are offered a standardized care plan under the Care Programme Approach (CPA). A crisis plan is a mandatory part of this standard; however, the quality and in particular the level of individualisation of these crisis plans are unknown. In this context, the aim of this study was to assess the quality of crisis planning and the impact of exposure to a specialized crisis planning intervention. Method. The crisis plans of 424 participants were assessed, before and after exposure to the Joint Crisis Plan (JCP) intervention, for 'individualisation' (i.e., at least one item of specific and identifiable information about an individual). Associations of individualisation were investigated. Results. A total of 15% of crisis plans were individualised at baseline. There was little or no improvement following exposure to the JCP. Individualised crisis plans were not associated with a history of prior crises or incidences of harm to self and others. Conclusions. Routine crisis planning for individuals with serious mental illness is not influenced by clinical risk profiles. 'Top down' implementation of the policy is unlikely to generate the best practice and compliance if clinicians do not perceive the clinical value in the process.

Safety in home care: a mapping review of the international literature

Aim This integrative study on safety in home care provides a synopsis of evidence in the Canadian and international literature. The objectives of this study were to: (i) develop/test a comprehensive search strategy to locate the literature on harmful incidents (previously called adverse events (AEs)) in the home care environment to track emerging evidence; (ii) determine what has been documented about AEs in the home care setting; and (iii) catalogue definitions of safety in home care by analysis of reported/published definitions. Methods The review was characterised by a process of mapping and categorising existing literature in practice, health services and policy literature. Methods included a thorough search strategy determined by time/scope constraints, quality assessment of study sets relevant to design and graphic/tabular representation of the synthesis. This multi-step, iterative process used an explicit search and retrieval strategy based on Cochrane and Joanna Briggs Institute methodologies. A modified Problem, Intervention, Comparison, Outcome template was used to design the search. To facilitate concept clarification, key definitions relevant to patient safety and AEs in home care were catalogued. Results Multiple runs on searches were performed for sensitivity and specificity using the Peer Review of Electronic Search Strategies methodology developed by the Canadian Agency for Drugs and Technologies in Health and additional other approaches. Ninety-two research studies published from 1993 to 2010 and representing 14 countries (the majority North American) met the inclusion criteria (i.e. addressing AEs within the context of home care). Studies varied in scope from one home healthcare agency/site to nationwide investigations that involved more than five million participants. Quantitative research methods included experimental, descriptive and retrospective designs. Qualitative research methods included focus groups, interviews and consensus workshops. The nature of AEs was categorised as types of patient injury/harm related to an AE, caregiver instigated injury/harm and organisational/services/staff injury/harm. Conclusions There is an emerging evidence base about safety in home care. A predominant theme was the lack of conceptual clarity with the terms patient safety and AEs in the home care environment. An important finding was that innovative strategies/tools appear in the grey or peer-review literature as quality initiatives with/without evaluation elements. Traditionally, we do not concentrate heavily on the grey literature, but to advance the field, it may be necessary to place more emphasis on this source. A glaring limitation was the paucity of research on the occurrence of AEs and a lack of quality of research that documents prevalence estimates/incidence rates. Interventional research to evaluate risk reduction strategies was very limited and will advance only when tracking and documentation of various AEs improves.

Retrospective record review in proactive patient safety work – identification of no-harm incidents

BackgroundIn contrast to other safety critical industries, well-developed systems to monitor safety within the healthcare system remain limited. Retrospective record review is one way of identifying adverse events in healthcare. In proactive patient safety work, retrospective record review could be used to identify, analyze and gain information and knowledge about no-harm incidents and deficiencies in healthcare processes. The aim of the study was to evaluate retrospective record review for the detection and characterization of no-harm incidents, and compare findings with conventional incident-reporting systems.MethodsA two-stage structured retrospective record review of no-harm incidents was performed on a random sample of 350 admissions at a Swedish orthopedic department. Results were compared with those found in one local, and four national incident-reporting systems.ResultsWe identified 118 no-harm incidents in 91 (26.0%) of the 350 records by retrospective record review. Ninety-four (79.7%) no-harm incidents were classified as preventable. The five incident-reporting systems identified 16 no-harm incidents, of which ten were also found by retrospective record review. The most common no-harm incidents were related to drug therapy (n = 66), of which 87.9% were regarded as preventable.ConclusionsNo-harm incidents are common and often preventable. Retrospective record review seems to be a valuable tool for identifying and characterizing no-harm incidents. Both harm and no-harm incidents can be identified in parallel during the same record review. By adding a retrospective record review of randomly selected records to conventional incident-reporting, health care providers can gain a clearer and broader picture of commonly occurring, no-harm incidents in order to improve patient safety.

Memorial Hermann: High Reliability from Board to Bedside

In 2006 the Memorial Hermann Health System (MHHS), which includes 12 hospitals, began applying principles embraced by high reliability organizations (HROs). Three factors support its HRO journey: (1) aligned organizational structure with transparent management systems and compressed reporting processes; (2) Robust Process Improvement (RPI) with high-reliability interventions; and (3) cultural establishment, sustainment, and evolution. The Quality and Safety strategic plan contains three domains, each with a specific set of measures that provide goals for performance: (1) "Clinical Excellence;" (2) "Do No Harm;" and (3) "Saving Lives," as measured by the Serious Safety Event rate. MHHS uses a uniform approach to performance improvement--RPI, which includes Six Sigma, Lean, and change management, to solve difficult safety and quality problems. The 9 acute care hospitals provide multiple opportunities to integrate high-reliability interventions and best practices across MHHS. For example, MHHS partnered with the Joint Commission Center for Transforming Healthcare in its inaugural project to establish reliable hand hygiene behaviors, which improved MHHS's average hand hygiene compliance rate from 44% to 92% currently. Soon after compliance exceeded 85% at all 12 hospitals, the average rate of central line-associated bloodstream and ventilator-associated pneumonias decreased to essentially zero. MHHS's size and diversity require a disciplined approach to performance improvement and systemwide achievement of measurable success. The most significant cultural change at MHHS has been the expectation for 100% compliance with evidence-based quality measures and 0% incidence of patient harm.